Contraceptive methods compared
Two numbers decide how reliable a method is: the Pearl index with perfect use and the one with typical use. For the pill they differ by a factor of 20. This comparison shows both, along with hormone content, duration, effort and cost – filterable by what matters to you.
| Method | In everyday use | Perfect use | Hormones | Lasts | Cost |
|---|---|---|---|---|---|
|
Contraceptive implant Long-acting methods |
0,05 of 100 women per year | 0,05 | Etonogestrel | 3 years | around € 300 including insertion |
|
Vasectomy Permanent methods |
0,15 of 100 women per year | 0,10 | none | permanent | € 600 to 1,000 |
|
Hormonal coil (IUS) Long-acting methods |
0,20 of 100 women per year | 0,20 | Levonorgestrel, locally in the uterus | 3 to 8 years | € 500 to 750 for the whole duration |
|
Female sterilisation Permanent methods |
0,50 of 100 women per year | 0,50 | none | permanent | a procedure, usually paid privately |
|
Copper coil (IUD) Long-acting methods |
0,80 of 100 women per year | 0,60 | none | 5 to 10 years | € 500 to 600 for the whole duration |
|
Symptothermal method Natural methods |
1,8 of 100 women per year | 0,40 | none | daily | one-off, for a thermometer and a course |
|
Contraceptive injection Long-acting methods |
6,0 of 100 women per year | 0,20 | Medroxyprogesterone acetate | 3 months | € 85 per appointment including check-up and ultrasound |
|
Combined pill Daily methods |
7,0 of 100 women per year | 0,30 | Oestrogen and progestogen | daily | € 5 to 20 a month |
|
Progestogen-only pill Daily methods |
7,0 of 100 women per year | 0,30 | Progestogen alone (desogestrel or drospirenone) | daily | € 8 to 20 a month |
|
Vaginal ring Daily methods |
7,0 of 100 women per year | 0,30 | Oestrogen and progestogen | 3 weeks per ring | around € 20 a month |
|
Contraceptive patch Daily methods |
7,0 of 100 women per year | 0,30 | Oestrogen and progestogen | 1 week per patch | around € 20 a month |
|
Diaphragm with gel Barrier methods |
12,0 of 100 women per year | 6,0 | none | per act | around € 50 for the diaphragm, plus gel |
|
Condom Barrier methods |
13,0 of 100 women per year | 2,0 | none | per act | € 0.30 to 1 each |
|
Withdrawal Natural methods |
20,0 of 100 women per year | 4,0 | none | per act | none |
|
Calendar method Natural methods |
24,0 of 100 women per year | 5,0 | none | daily | none |
The methods in detail
Contraceptive implant · 0,05 of 100
What speaks for it: The most reliable reversible method of all – more reliable than sterilisation. There is nothing to forget.
What speaks against it: The bleeding pattern is unpredictable: anything from no bleeding at all to persistent spotting is possible, and there is no way to say in advance which it will be.
Effort: nothing day to day · Cost: around € 300 including insertion
Vasectomy · 0,15 of 100
What speaks for it: A minor procedure under local anaesthetic, more reliable and with fewer complications than female sterilisation.
What speaks against it: It cannot be reversed. Protection only begins once two semen samples show no sperm – usually after three months.
Effort: nothing day to day · Cost: € 600 to 1,000
Hormonal coil (IUS) · 0,20 of 100
What speaks for it: Bleeding becomes lighter, and in about one woman in five it stops altogether. That is why the hormonal coil is also a first-line treatment for heavy and painful periods – quite apart from contraception.
What speaks against it: Irregular spotting is the rule in the first three to six months. Fitting is uncomfortable; how uncomfortable depends considerably on how it is done.
Effort: nothing day to day · Cost: € 500 to 750 for the whole duration
Female sterilisation · 0,50 of 100
What speaks for it: Permanent and requiring nothing further.
What speaks against it: It cannot be reversed. Worth noting: the implant and the hormonal coil are statistically more reliable.
Effort: nothing day to day · Cost: a procedure, usually paid privately
Copper coil (IUD) · 0,80 of 100
What speaks for it: Completely hormone-free; the cycle stays your own. As emergency contraception up to five days after intercourse it is by far the most effective method there is.
What speaks against it: In many women bleeding becomes heavier and longer and period pain increases. If you already bleed heavily, it is usually the wrong choice.
Effort: nothing day to day · Cost: € 500 to 600 for the whole duration
Symptothermal method · 1,8 of 100
What speaks for it: Used consistently and after proper training, considerably more reliable than its reputation – the figures come from the Heidelberg study of 900 women over 17,638 cycles (Frank-Herrmann et al., 2007). Hormone-free and immediately usable when you want to conceive.
What speaks against it: It demands discipline and abstinence on the fertile days. Fever, shift work, travel and irregular sleep disturb the readings. Not to be confused with the calendar method, which is far less reliable.
Effort: daily measurement and charting · Cost: one-off, for a thermometer and a course
Contraceptive injection · 6,0 of 100
What speaks for it: A good option when taking something daily does not work reliably and a coil is not suitable.
What speaks against it: After stopping it often takes six to twelve months for ovulation to return – the wrong choice if you want to conceive in the foreseeable future. In the long term bone density decreases.
Effort: one appointment per quarter · Cost: € 85 per appointment including check-up and ultrasound
Combined pill · 7,0 of 100
What speaks for it: Regular, lighter and less painful bleeding; helps with acne and premenstrual syndrome. Markedly and lastingly reduces the risk of ovarian and endometrial cancer.
What speaks against it: It raises the risk of thrombosis – which is why it is unsuitable for smokers over 35, after a thrombosis, or with migraine with aura. The commonest reason for an unintended pregnancy while using contraception is a forgotten pill.
Effort: a tablet every day · Cost: € 5 to 20 a month
Progestogen-only pill · 7,0 of 100
What speaks for it: No oestrogen and therefore none of its thrombosis risk – suitable while breastfeeding, with migraine with aura, and for smokers over 35.
What speaks against it: The window for taking it is narrower than with the combined pill, and the bleeding pattern becomes irregular.
Effort: a tablet every day, without a break · Cost: € 8 to 20 a month
Vaginal ring · 7,0 of 100
What speaks for it: The same effect as the combined pill, but something to remember twelve times a year instead of 365. Stomach upsets do not affect it.
What speaks against it: The same thrombosis risk as the combined pill. Some women feel the ring or find it intrusive during intercourse.
Effort: change once a month · Cost: around € 20 a month
Contraceptive patch · 7,0 of 100
What speaks for it: Visible – you can see at once whether it is still on. Independent of the digestive tract.
What speaks against it: Above a body weight of 90 kg it works less well. The oestrogen exposure is higher than with the pill.
Effort: change weekly · Cost: around € 20 a month
Diaphragm with gel · 12,0 of 100
What speaks for it: Hormone-free and entirely under your own control; reusable for years.
What speaks against it: It has to be fitted and its use practised. More frequent urinary tract infections.
Effort: every time, with preparation · Cost: around € 50 for the diaphragm, plus gel
Condom · 13,0 of 100
What speaks for it: The only method that also protects against sexually transmitted infections. Available everywhere, no side effects, no prerequisites.
What speaks against it: The gap between perfect and typical use is wider than for any other common method – 2 against 13.
Effort: every time · Cost: € 0.30 to 1 each
Withdrawal · 20,0 of 100
What speaks for it: Always available.
What speaks against it: One woman in five becomes pregnant within a year. Not advisable as the only method.
Effort: every time · Cost: none
Calendar method · 24,0 of 100
What speaks for it: It costs nothing and needs no equipment.
What speaks against it: Almost one woman in four becomes pregnant within a year. Ovulation varies by several days even in regular cycles – a calendar cannot capture that.
Effort: keeping a calendar · Cost: none
The two numbers – and why only one of them answers your question
The Pearl index says how many out of 100 women become pregnant within a year using a method. It exists twice: for perfect use, and for typical use. For the pill they are 0.3 and 7 – a factor of more than twenty. The pill has not become worse; people forget it.
This gap is the strongest argument for the long-acting methods. Coil, implant and injection have almost identical figures for perfect and typical use – because after they are fitted, there is nothing left to do wrong. That is why an implant is statistically more reliable than sterilisation.
What no table can decide
Whether a method suits you depends on things that do not appear in any column: previous thrombosis, migraine with aura, smoking after 35, heavy periods, plans for a child in two years, whether you can remember a daily tablet – and what you want your bleeding to do. That conversation is what a consultation is for.
Arrange a contraception consultation Compare coils in detail
Sources
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Trussell J: Contraceptive failure in the United States. Contraception 83 (2011) 397–404
The dataset the guidelines draw on for their figures on perfect and typical use. - Frank-Herrmann P u. a.: The effectiveness of a fertility awareness based method. Human Reproduction 22 (2007) 1310–1319
- Faculty of Sexual and Reproductive Healthcare: Combined Hormonal Contraception
It works with averages. Your body does not. The result is a starting point for a conversation, not a finding – and it cannot see what an examination would show.
Questions about your result? Arrange an appointment.